<!DOCTYPE html>
<!--suppress ALL-->
<html lang="en" xmlns:th="http://www.thymeleaf.org">
<div th:replace="pages/admin/commons/header :: header"></div>
<body style="background-color:#fff">
<div class="wap-container">
    <div class="panel">
        <div class="panel-body">
            <form enctype="multipart/form-data" style="margin-left: 15%" action="/childhealth/basicData/data-upd"
                  method="post"
                  class="form form-horizontal"
                  id="form-member-add">
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>基本资料</b></label>
                <div class="row clearfix">
                    <br><br><br>
                    <input type="hidden" th:value="${type} == toUpd ? 'upd' : 'add'" name="type">

                    <input type="hidden" th:if="${result.id} != 0" th:value="${result.id}" name="id">
                    <input type="hidden" th:if="${result.id} == 0" name="id">

                </div>
                <!--头像s-->
                <div style="width: 150px;height: 150px;margin-left: 27%;margin-bottom: 5%">
                    <img class="userImage" th:if="${result.id} != 0" width="150px;" height="150px;" id="selectImg">
                    <img th:if="${result.id} == 0" width="150px;" height="150px;" id="selectImg">
                </div>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>头像：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                  <span class="btn-upload">
                    <a href="javascript:void(0);" class="btn btn-primary radius btn-upload"><i class="Hui-iconfont">&#xe642;</i> 浏览文件</a>
                    <input onchange="xmTanUploadImg(this)" type="file" name="file" id="uploadImg" class="input-file">
				 </span>
                </div>
                <br><br><br>
                <!--头像e-->
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>档案号：</label>
                <div class="form-controls col-xs-8 col-sm-9">

                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.dah}"
                           name="dah">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0" placeholder="档案号"
                           name="dah">

                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>姓名：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xm}"
                           name="xm">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="姓名"
                           name="xm">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>性别：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="xb">
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>出生日期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" id="test2" type="text" required lay-verify="required" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.csrq}"
                           placeholder="出生日期"
                           name="csrq">
                    <input style="width: 30%" id="test1" type="text" required lay-verify="required" class="input-text"
                           th:if="${result.id} == 0" placeholder="出生日期"
                           name="csrq">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生孕周：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.csyz}"
                           name="csyz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生孕周"
                           name="csyz">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>建档日期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" id="test2" type="text" required lay-verify="required" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jdrq}"
                           name="jdrq">
                    <input style="width: 30%" id="test1" type="text" required lay-verify="required" class="input-text"
                           th:if="${result.id} == 0" placeholder="建档日期"
                           name="jdrq">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>建档年龄：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jdnl}"
                           name="jdnl">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="建档年龄"
                           name="jdnl">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>现在年龄：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xznl}"
                           name="xznl">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="现在年龄"
                           name="xznl">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>建档医生：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="jdys">
                                    <option value="刘金兰">刘金兰</option>
                                    <option value="刘灯华">刘灯华</option>
                                    <option value="谭少荣">谭少荣</option>
                                    <option value="贺艳">贺艳</option>
                                    <option value="朱陈兰">朱陈兰</option>
                                    <option value="赵艳玲">赵艳玲</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>建档医院：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jdyy}"
                           name="jdyy">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="建档医院" value="萍乡市莲花县妇幼保健院"
                           name="jdyy">
                    <a href="javascript:$('[name=jdyy]').val('');;" class="btn btn-success radius" type="button"><i
                            class="Hui-iconfont"></i> 清除</a>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>国籍：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="gj">
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>民族：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="mz">
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>户籍情况：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="hjqk">
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>农籍：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <div class="radio-box">
                        <input name="nj" value="农籍" type="radio" id="sex-1" checked>
                        <label for="sex-1">农籍</label>
                    </div>
                    <div class="radio-box">
                        <input type="radio" value="非农籍" id="sex-2" name="nj">
                        <label for="sex-2">非农籍</label>
                    </div>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>居住：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="jz">
                                    <option value="常住">常住</option>
                                    <option value="暂住">暂住</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-green">*</span>健康档案编号：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jkdabh}"
                           name="jkdabh">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="健康档案编号"
                           name="jkdabh">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>身份证号码：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.sfzhm}"
                           name="sfzhm">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="身份证号码"
                           name="sfzhm">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生身长(cm)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cssc1}"
                           name="cssc1">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生身长(cm)"
                           name="cssc1">

                    <span class="select-box" style="width: 20%;">
                                <select class="select" name="cssc2">
                                    <option value=""></option>
                                    <option value="测量">测量</option>
                                    <option value="估计">估计</option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生体重(g)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cstz1}"
                           name="cstz1">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生体重(g)"
                           name="cstz1">

                    <span class="select-box" style="width: 20%;">
                                <select class="select" name="cstz2">
                                    <option value=""></option>
                                    <option value="测量">测量</option>
                                    <option value="估计">估计</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>孕次：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.yc}"
                           name="yc">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="孕次"
                           name="yc">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>产次：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cc1}"
                           name="cc1">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="产次"
                           name="cc1">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>分娩方式：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fmfs">
                                    <option value=""></option>
                                    <option value="臀牵引">臀牵引</option>
                                    <option value="自然分娩">自然分娩</option>
                                    <option value="胎吸">胎吸</option>
                                    <option value="刨宫产">刨宫产</option>
                                    <option value="臀助产">臀助产</option>
                                    <option value="产钳术">产钳术</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>胎数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="ts">
                                    <option value=""></option>
                                    <option value="单胎">单胎</option>
                                    <option value="双胎">双胎</option>
                                    <option value="三胎及以上">三胎及以上</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>胎次：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.tc}"
                           name="tc">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="胎次"
                           name="tc">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>早产：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input th:if="${result.id} != 0" type="checkbox" name="zc"
                           th:checked="${result.zc} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zc">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>预产期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ycq}"
                           name="ycq">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="预产期"
                           name="ycq">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>窒息：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="zx">
                                    <option value=""></option>
                                    <option value="无">无</option>
                                    <option value="轻">轻</option>
                                    <option value="中">中</option>
                                    <option value="重">重</option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>破伤风：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="psf">
                                    <option value=""></option>
                                    <option value="有">有</option>
                                    <option value="无">无</option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>ABO血型：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="aboxx">
                                    <option value=""></option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>RH血型：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="rhxx">
                                    <option value=""></option>
                                    <option value="阴性">阴性</option>
                                    <option value="阳性">阳性</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>阿氏评分：</b></label>
                <div class="form-controls col-xs-8 col-sm-9">
                    产时
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cs}"
                           name="cs">
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="产时"
                           name="cs">

                    产后5分钟
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ch5fz}"
                           name="ch5fz">
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="产后5分钟"
                           name="ch5fz">
                    产后10分钟
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ch10fz}"
                           name="ch10fz">
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="产后10分钟"
                           name="ch10fz">
                    <br>
                    记录创建时间: &nbsp;&nbsp;
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jlcjsj}"
                           name="jlcjsj">
                    <input disabled style="width: 15%;background: #dedbdb" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="创建记录时间"
                           name="jlcjsj">


                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>接生医院：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jsyy}"
                           name="jsyy">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="接生医院" value="萍乡市莲花县妇幼保健院"
                           name="jsyy">
                    <a href="javascript:$('[name=jsyy]').val('');;" class="btn btn-success radius" type="button"><i
                            class="Hui-iconfont"></i> 清除</a>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>接生地点分类：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="jsddfl">
                                    <option value=""></option>
                                    <option value="省级医院">省级医院</option>
                                    <option value="地市及医院">地市及医院</option>
                                    <option value="区县级医院">区县级医院</option>
                                    <option value="街道(乡镇)医院">街道(乡镇)医院</option>
                                    <option value="接生室">接生室</option>
                                    <option value="家中">家中</option>
                                    <option value="途中">途中</option>
                                    <option value="省级保健院">省级保健院</option>
                                    <option value="地市级保健院">地市级保健院</option>
                                    <option value="区县级保健院">区县级保健院</option>
                                    <option value="民营医院">民营医院</option>
                                    <option value="其他">其他</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><span
                        style="background-color: yellow">出生缺陷</span>：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.csqx}"
                           name="csqx">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生缺陷"
                           name="csqx">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生史：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.css}"
                           name="css">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生史"
                           name="css">
                </div>
                <br><br><br>
                <HR style=" border:1px dashed #334455">

                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>户口地址：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.hkdz}"
                           name="hkdz">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="户口地址" value="江西省萍乡市莲花县琴亭镇"
                           name="hkdz">
                    <a href="javascript:$('[name=hkdz]').val('');" class="btn btn-success radius" type="button"><i
                            class="Hui-iconfont"></i> 清除</a>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>已落户：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input th:if="${result.id} != 0" type="checkbox" name="ylh"
                           th:checked="${result.ylh} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="ylh">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>现住地址：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xzdz}"
                           name="xzdz">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="现住地址" value="江西省萍乡市莲花县琴亭镇"
                           name="xzdz">
                    <a href="javascript:$('[name=xzdz]').val('');" class="btn btn-success radius" type="button"><i
                            class="Hui-iconfont"></i> 清除</a>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>转档：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input th:if="${result.id} != 0" type="checkbox" name="zd"
                           th:checked="${result.zd} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zd">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>管辖属地：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.gxsd}"
                           name="gxsd">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="管辖属地" value="江西省萍乡市莲花县琴亭镇"
                           name="gxsd">
                    <a href="javascript:$('[name=gxsd]').val('');" class="btn btn-success radius" type="button"><i
                            class="Hui-iconfont"></i> 清除</a>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>归属单位：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.gsdw}"
                           name="gsdw">
                    <input style="width: 30%" required lay-verify="required" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="归属单位"
                           name="gsdw">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>儿保医院：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ebyy}"
                           name="ebyy">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="儿保医院"
                           name="ebyy"> 本单位
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>母亲户口地：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqhkd}"
                           name="mqhkd">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="母亲户口地"
                           name="mqhkd">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>断奶时间：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.dnsj}"
                           name="dnsj">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="断奶时间"
                           name="dnsj"><span style="color: green">(月龄)</span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>六月内纯母乳：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="lyncmr">
                                    <option value=""></option>
                                    <option value="纯母乳">纯母乳</option>
                                    <option value="混合喂养">混合喂养</option>
                                    <option value="人工喂养">人工喂养</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>调查时间：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.dcsj}"
                           name="dcsj">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="调查时间"
                           name="dcsj">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>首次辅食添加时间：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.scfstjsj}"
                           name="scfstjsj">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="首次辅食添加时间"
                           name="scfstjsj"><span style="color: green">(月)</span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>辅食添加品种：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fstjpz}"
                           name="fstjpz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="辅食添加品种"
                           name="fstjpz">
                </div>
                <br><br><br>
                <HR style=" border:1px dashed #334455">
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>联系电话</b></label>
                <div class="row clearfix">
                    <br><br><br>
                </div>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><span style="color: red">联系电话(最常用手机)：</span></label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input required lay-verify="required" style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.lxdh}"
                           name="lxdh">
                    <input required lay-verify="required" style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="联系电话(最常用手机)"
                           name="lxdh">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>父亲电话：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqdh}"
                           name="fqdh">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="父亲电话"
                           name="fqdh">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>母亲电话：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqdh}"
                           name="mqdh">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="母亲电话"
                           name="mqdh">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>监护人：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jhr}"
                           name="jhr">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="监护人"
                           name="jhr">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>监护人关系：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="jhrgx">
                                    <option value=""></option>
                                    <option value="丈夫">丈夫</option>
                                    <option value="妻子">妻子</option>
                                    <option value="母亲">母亲</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><span
                        style="color: red">短信服务</span>：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input th:if="${result.id} != 0" type="checkbox" name="yytz"
                           th:checked="${result.yytz} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="yytz"> 预约通知
                </div>
                <br><br><br>

                <HR style=" border:1px dashed #334455">
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>父亲</b></label>
                <div class="row clearfix">
                    <br><br><br>
                </div>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>姓名：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqxm}"
                           name="fqxm">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="姓名"
                           name="fqxm">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生日期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqcsrq}"
                           name="fqcsrq">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生日期"
                           name="fqcsrq">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>年龄：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqnl}"
                           name="fqnl">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="年龄"
                           name="fqnl">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>文化程度：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fqwhcd">
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>身高(cm)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqsg}"
                           name="fqsg">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="身高"
                           name="fqsg">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>国籍：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fqgj">
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>民族：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fqmz">
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>职业：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fqzy">
                                    <option value=""></option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>单位：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqdw}"
                           name="fqdw">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="单位"
                           name="fqdw">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>疾病：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqjb}"
                           name="fqjb">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="疾病"
                           name="fqjb">
                </div>
                <br><br><br>


                <!--                -->
                <HR style=" border:1px dashed #334455">
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>母亲</b></label>
                <div class="row clearfix">
                    <br><br><br>
                </div>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red">*</span>姓名：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input required lay-verify="required" style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqxm}"
                           name="mqxm">
                    <input required lay-verify="required" style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="姓名"
                           name="mqxm">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生日期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqcsrq}"
                           name="mqcsrq">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生日期"
                           name="mqcsrq">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>年龄：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqnl}"
                           name="mqnl">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="年龄"
                           name="mqnl">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>文化程度：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="mqwhcd">
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>身高(cm)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqsg}"
                           name="mqsg">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="身高"
                           name="mqsg">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>国籍：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="mqgj">
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>民族：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="mqmz">
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>职业：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="mqzy">
                                    <option value=""></option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>单位：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqdw}"
                           name="mqdw">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="单位"
                           name="mqdw">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>疾病：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqjb}"
                           name="mqjb">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="疾病"
                           name="mqjb">
                </div>
                <br><br><br>
                <HR style=" border:1px dashed #334455">
                <br><br><br>

                <!--                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>母亲</label>-->
                <!--                <div class="row clearfix">-->
                <!--                    <br><br><br>-->
                <!--                </div>-->

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>与遗传有关的家族史：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="ycygjzs1">
                                    <option value="无">无</option>
                                    <option value="有">有</option>
                                </select>
                            </span>
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0" th:value="${result.ycygjzs2}"
                           name="ycygjzs2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="与遗传有关的家族史" value="无"
                           name="ycygjzs2">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>患者与儿童关系：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.hzyetgx}"
                           name="hzyetgx">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="患者与儿童关系"
                           name="hzyetgx">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>过敏史：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="gms1">
                                    <option value="无">无</option>
                                    <option value="有">有</option>
                                </select>
                            </span>
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0" th:value="${result.gms2}"
                           name="gms2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="过敏史" value="无"
                           name="gms2">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>新生儿疾病筛查：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="xsejbsc1">
                                    <option value="未筛查">未筛查</option>
                                    <option value="已筛查">已筛查</option>
                                </select>
                            </span>
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0" th:value="${result.xsejbsc2}"
                           name="xsejbsc2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="与遗传有关的家族史" value="无"
                           name="xsejbsc2">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>备注：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.bz}"
                           name="bz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="备注"
                           name="bz">
                </div>
                <br><br><br>
                <HR style=" border:1px dashed #334455">
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>结案</b></label>
                <div class="row clearfix">
                    <br><br><br>
                </div>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>转出：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input th:if="${result.id} != 0" type="checkbox" name="zc2"
                           th:checked="${result.zc2} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zc2"> &nbsp;&nbsp;

                    转出日期<input style="width: 20%" type="text" class="input-text"
                               th:if="${result.id} != 0"
                               th:value="${result.zcrq}"
                               name="zcrq">
                    <input style="width: 20%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="转出日期"
                           name="zcrq">
                    转出原因&nbsp;&nbsp;<span class="select-box" style="width: 20%;">
                                <select class="select" name="zcyy">
                                    <option value=""></option>
                                    <option value="搬家">搬家</option>
                                    <option value="换医院">换医院</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>死亡：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input th:if="${result.id} != 0" type="checkbox" name="sw"
                           th:checked="${result.sw} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="sw"> &nbsp;&nbsp;

                    死亡时间<input style="width: 20%" type="text" class="input-text"
                               th:if="${result.id} != 0"
                               th:value="${result.swsj}"
                               name="swsj">
                    <input style="width: 20%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="死亡时分"
                           name="swsj">
                    死亡地点<input style="width: 20%" type="text" class="input-text"
                               th:if="${result.id} != 0"
                               th:value="${result.swdd}"
                               name="swdd">
                    <input style="width: 20%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="死亡地点"
                           name="swdd">
                    死亡原因<input style="width: 20%" type="text" class="input-text"
                               th:if="${result.id} != 0"
                               th:value="${result.swyy}"
                               name="swyy">
                    <input style="width: 20%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="死亡原因"
                           name="swyy">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>结案：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input th:if="${result.id} != 0" type="checkbox" name="ja"
                           th:checked="${result.ja} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="ja"> &nbsp;&nbsp;

                    结案日期<input style="width: 15%" type="text" class="input-text"
                               th:if="${result.id} != 0"
                               th:value="${result.jarq}"
                               name="jarq">
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="结案日期"
                           name="jarq">

                    结案医生&nbsp;&nbsp;<span class="select-box" style="width: 15%;">
                                <select class="select" name="jays">
                                    <option value=""></option>
                                    <option value="刘金兰">刘金兰</option>
                                    <option value="刘灯华">刘灯华</option>
                                    <option value="谭少荣">谭少荣</option>
                                    <option value="朱陈兰">朱陈兰</option>
                                    <option value="赵艳玲">赵艳玲</option>
                                </select>
                            </span>

                    结案原因<input style="width: 15%" type="text" class="input-text"
                               th:if="${result.id} != 0"
                               th:value="${result.jayy}"
                               name="jayy">
                    <input style="width: 15%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="结案原因"
                           name="jayy">
                    <br>
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    结案单位 <input style="width: 15%;margin-left: 3px;" type="text" class="input-text"
                                th:if="${result.id} != 0"
                                th:value="${result.jadw}"
                                name="jadw">
                    <input style="width: 15%;margin-left: 3px;" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="结案单位"
                           name="jadw">
                </div>
                <br><br><br> <br><br><br>

                <HR style=" border:1px dashed #334455">
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>孕期情况</b></label>
                <div class="row clearfix">
                    <br><br><br>
                </div>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>年龄：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.nl}"
                           name="nl">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="年龄"
                           name="nl">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>妊娠反应：</label>
                <div class="form-controls col-xs-8 col-sm-9">

                    <span class="select-box" style="width: 30%;">
                                <select class="select" name="rsfy">
                                    <option value=""></option>
                                    <option value="无">无</option>
                                    <option value="轻">轻</option>
                                    <option value="中">中</option>
                                    <option value="重">重</option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>近亲结婚：</label>
                <div class="form-controls col-xs-8 col-sm-9">

                    <span class="select-box" style="width: 30%;">
                                <select class="select" name="jqjh">
                                    <option value=""></option>
                                    <option value="否">否</option>
                                    <option value="是">是</option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>营养：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <span class="select-box" style="width: 30%;">
                                <select class="select" name="yy">
                                    <option value=""></option>
                                    <option value="好">好</option>
                                    <option value="中">中</option>
                                    <option value="差">差</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><span
                        style="background-color: yellow">孕期患病</span>：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.yqhb}"
                           name="yqhb">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="孕期患病"
                           name="yqhb">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><span
                        style="background-color: yellow">家族史</span>：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jzs}"
                           name="jzs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="家族史"
                           name="jzs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><span
                        style="background-color: yellow">先天疾病</span>：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xtjb}"
                           name="xtjb">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="先天疾病"
                           name="xtjb">
                </div>
                <br><br><br>


                <HR style=" border:1px dashed #334455">
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>孕产史</b></label>
                <div class="row clearfix">
                    <br><br><br>
                </div>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>孕次：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.yc2}"
                           name="yc2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="孕次"
                           name="yc2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>产次：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cc2}"
                           name="cc2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="产次"
                           name="cc2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>自然流产次数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.zrlccs}"
                           name="zrlccs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="自然流产次数"
                           name="zrlccs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>人工流产次数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.rglccs}"
                           name="rglccs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="人工流产次数"
                           name="rglccs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>中期引产次数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.zqyccs}"
                           name="zqyccs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="中期引产次数"
                           name="zqyccs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>早产次数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.zccs}"
                           name="zccs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="早产次数"
                           name="zccs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>自然产次数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.zrccs}"
                           name="zrccs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="自然产次数"
                           name="zrccs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>阴道助产次数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ydzccs}"
                           name="ydzccs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="阴道助产次数"
                           name="ydzccs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>剖宫产次数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.pgccs}"
                           name="pgccs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="剖宫产次数"
                           name="pgccs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>死胎数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.sts}"
                           name="sts">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="死胎数"
                           name="sts">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>死产数：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.scs}"
                           name="scs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="死产数"
                           name="scs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span
                        class="c-red"></span>出生缺陷儿数[[${result.csqxes}]]：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.csqxes}"
                           name="csqxes">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生缺陷儿数"
                           name="csqxes">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>前次分娩时间：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.qcfmsj}"
                           name="qcfmsj">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="前次分娩时间"
                           name="qcfmsj">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>前次分娩方式：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                   <span class="select-box" style="width: 30%;">
                                <select class="select" name="qcfmfs">
                                    <option value=""></option>
                                    <option value="臀引产">臀引产</option>
                                    <option value="自然分娩">自然分娩</option>
                                    <option value="胎吸">胎吸</option>
                                    <option value="剖宫产">剖宫产</option>
                                    <option value="臀助产">臀助产</option>
                                    <option value="产钳术">产钳术</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>末次流产时间：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mclcsj}"
                           name="mclcsj">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="末次流产时间"
                           name="mclcsj">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>末次流产方式：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                   <span class="select-box" style="width: 30%;">
                                <select class="select" name="mclcfs">
                                    <option value=""></option>
                                    <option value="无">无</option>
                                    <option value="人工流产">人工流产</option>
                                    <option value="自然流产">自然流产</option>
                                    <option value="药物流产">药物流产</option>
                                    <option value="中期引产">中期引产</option>
                                    <option value="难产">难产</option>
                                    <option value="手术产">手术产</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>妊娠合并症：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.rshbz}"
                           name="rshbz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="妊娠合并症"
                           name="rshbz">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>妊娠并发症：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.rsbfz}"
                           name="rsbfz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="妊娠并发症"
                           name="rsbfz">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>其他异常孕产史：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.qtycycs}"
                           name="qtycycs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="其他异常孕产史"
                           name="qtycycs">
                </div>
                <br><br><br>


                <div class="row clearfix">
                    <div class="col-xs-8 col-sm-9 col-xs-offset-4 col-sm-offset-3">
                        <button style=" margin-left: inherit" class="btn btn-primary radius" type="submit">
                            [[${type}=='toUpd'? '修改':'添加']]
                        </button>
                    </div>
                </div>
            </form>
        </div>
    </div>
</div>
<div th:replace="pages/admin/commons/footer :: footer"></div>
<script th:src="@{/layui/layui.js}" charset="utf-8"></script>
<script type="text/javascript">


    $.ajax({
        url: "/childhealth/dataDictionary/getNodeInfo/79",//查询职业
        method: "POST",
        success: function (result) {
            $.each(result.data, function (index, item) {
                var opt1 = $("<option value='" + item.value + "'></option>").append(item.value);
                var opt2 = $("<option value='" + item.value + "'></option>").append(item.value);
                $("[name=fqzy]").append(opt1);
                $("[name=mqzy]").append(opt2);
            })
            var fqzy = '[[${result.fqzy}]]';
            $("[name=fqzy] option[value= " + fqzy + "]").prop("selected", true);
            var mqzy = '[[${result.mqzy}]]';
            $("[name=mqzy] option[value= " + mqzy + "]").prop("selected", true);
        }
    });
    $.ajax({
        url: "/childhealth/dataDictionary/getNodeInfo/68",//查询ABO血型
        method: "POST",
        success: function (result) {
            $.each(result.data, function (index, item) {
                var opt = $("<option value='" + item.value + "'></option>").append(item.value);
                $("[name=aboxx]").append(opt);
            })
            var aboxx = '[[${result.aboxx}]]';
            $("[name=aboxx] option[value= " + aboxx + "]").prop("selected", true);
        }
    });
    $.ajax({
        url: "/childhealth/dataDictionary/getNodeInfo/77",//查询文化程度
        method: "POST",
        success: function (result) {
            $.each(result.data, function (index, item) {
                var opt1 = $("<option value='" + item.value + "'></option>").append(item.value);
                var opt2 = $("<option value='" + item.value + "'></option>").append(item.value);
                var opt3 = $("<option value='" + item.value + "'></option>").append(item.value);
                $("[name=whcd]").append(opt1);
                $("[name=mqwhcd]").append(opt2);
                $("[name=fqwhcd]").append(opt3);
            })

            var fqwhcd = '[[${result.fqwhcd}]]';
            $("[name=fqwhcd] option[value= " + fqwhcd + "]").prop("selected", true);
            var mqwhcd = '[[${result.mqwhcd}]]';
            $("[name=mqwhcd] option[value= " + mqwhcd + "]").prop("selected", true);
        }
    });
    $.ajax({
        url: "/childhealth/dataDictionary/getNodeInfo/63",//查询户籍情况
        method: "POST",
        success: function (result) {
            $.each(result.data, function (index, item) {
                var opt = $("<option value='" + item.value + "'></option>").append(item.value);
                $("[name=hjqk]").append(opt);
            })

            var hjqk = '[[${result.hjqk}]]';
            $("[name=hjqk] option[value= " + hjqk + "]").prop("selected", true);
        }
    });
    $.ajax({
        url: "/childhealth/dataDictionary/getNodeInfo/34",//查询性别
        method: "POST",
        success: function (result) {
            $.each(result.data, function (index, item) {
                var opt = $("<option value='" + item.value + "'></option>").append(item.value);
                $("[name=xb]").append(opt);
            })
            var xb = '[[${result.xb}]]';
            $("[name=xb] option[value= " + xb + "]").prop("selected", true);
        }
    });
    $.ajax({
        url: "/childhealth/dataDictionary/getNodeInfo/75",//查询国籍
        method: "POST",
        success: function (result) {
            $.each(result.data, function (index, item) {
                var opt1 = $("<option value='" + item.value + "'></option>").append(item.value);
                var opt2 = $("<option value='" + item.value + "'></option>").append(item.value);
                var opt3 = $("<option value='" + item.value + "'></option>").append(item.value);
                $("[name=gj]").append(opt1);
                $("[name=fqgj]").append(opt2);
                $("[name=mqgj]").append(opt3);
            })
            $("[name=gj]").val("中国");//default china
            $("[name=fqgj]").val("中国");//default china
            $("[name=mqgj]").val("中国");//default china

            // 修改时默认选中下拉框
            var gj = '[[${result.gj}]]';
            $("[name=gj] option[value= " + gj + "]").prop("selected", true);
            var fqgj = '[[${result.fqgj}]]';
            $("[name=fqgj] option[value= " + fqgj + "]").prop("selected", true);
            var mqgj = '[[${result.mqgj}]]';
            $("[name=mqgj] option[value= " + mqgj + "]").prop("selected", true);

        }
    });
    $.ajax({
        url: "/childhealth/dataDictionary/getNodeInfo/76",//查询民族
        method: "POST",
        success: function (result) {
            $.each(result.data, function (index, item) {
                var opt1 = $("<option value='" + item.value + "'></option>").append(item.value);
                var opt2 = $("<option value='" + item.value + "'></option>").append(item.value);
                var opt3 = $("<option value='" + item.value + "'></option>").append(item.value);
                $("[name=mz]").append(opt1);
                $("[name=fqmz]").append(opt2);
                $("[name=mqmz]").append(opt3);
            })
            $("[name=mz]").val("汉族");//default
            $("[name=fqmz]").val("汉族");//default
            $("[name=mqmz]").val("汉族");//default

            var mz = '[[${result.mz}]]';
            $("[name=mz] option[value= " + mz + "]").prop("selected", true);
            var fqmz = '[[${result.fqmz}]]';
            $("[name=fqmz] option[value= " + fqmz + "]").prop("selected", true);
            var mqmz = '[[${result.mqmz}]]';
            $("[name=mqmz] option[value= " + mqmz + "]").prop("selected", true);
        }
    });

    //获取当前时间
    function getNowDate() {
        var now = new Date();
        var year = now.getFullYear(); //得到年份
        var month = now.getMonth();//得到月份
        var date = now.getDate();
        return year + "." + month + "." + date;
    }

    if ('[[${result.id}]]' == 0) {
        $("[name=jlcjsj]").val(getNowDate())
    }


    layui.use('laydate', function () {
        var laydate = layui.laydate;

        //执行一个laydate实例
        laydate.render({
            elem: '#test1', //指定元素
            type: 'datetime'
        });
        laydate.render({
            elem: '#test2', //指定元素
            type: 'datetime'
        });
    });


    //    显示头像
    if (window.FileReader) {
        function xmTanUploadImg(obj) {
            var file = obj.files[0];
            var reader = new FileReader();
            reader.readAsDataURL(file);
            reader.onload = function (e) {    //成功读取文件
                var img = document.getElementById("selectImg");
                img.src = e.target.result;   //或 img.src = this.result / e.target == this

                //实现点击下载图片功能
                // var xmTanDownload = document.getElementById("xmTanDownload");
                // xmTanDownload.setAttribute("href", e.target.result);  //给a标签设置href
            };
        }
    } else {
        alert("Not supported by your browser FileReader!");
    }


    $(function () {

        if ('[[${result.id}]]' != 0) {
            //修改时填充下拉框值
            var rsfy = '[[${result.rsfy}]]';
            $("[name=rsfy] option[value= " + rsfy + "]").prop("selected", true);
            var jdys = '[[${result.jdys}]]';
            $("[name=jdys] option[value= " + jdys + "]").prop("selected", true);
            var jz = '[[${result.jz}]]';
            $("[name=jz] option[value= " + jz + "]").prop("selected", true);
            var cssc2 = '[[${result.cssc2}]]';
            $("[name=cssc2] option[value= " + cssc2 + "]").prop("selected", true);
            var cstz2 = '[[${result.cstz2}]]';
            $("[name=cstz2] option[value= " + cstz2 + "]").prop("selected", true);
            var fmfs = '[[${result.fmfs}]]';
            $("[name=fmfs] option[value= " + fmfs + "]").prop("selected", true);
            var ts = '[[${result.ts}]]';
            $("[name=ts] option[value= " + ts + "]").prop("selected", true);
            var zx = '[[${result.zx}]]';
            $("[name=zx] option[value= " + zx + "]").prop("selected", true);
            var psf = '[[${result.psf}]]';
            $("[name=psf] option[value= " + psf + "]").prop("selected", true);
            var rhxx = '[[${result.rhxx}]]';
            $("[name=rhxx] option[value= " + rhxx + "]").prop("selected", true);
            var jsddfl = '[[${result.jsddfl}]]';
            $("[name=jsddfl] option[value=" + jsddfl + "]").prop("selected", true);
            var lyncmr = '[[${result.lyncmr}]]';
            $("[name=lyncmr] option[value=" + lyncmr + "]").prop("selected", true);
            var jhrgx = '[[${result.jhrgx}]]';
            $("[name=jhrgx] option[value=" + jhrgx + "]").prop("selected", true);
            var ycygjzs1 = '[[${result.ycygjzs1}]]';
            $("[name=ycygjzs1] option[value=" + ycygjzs1 + "]").prop("selected", true);
            var gms1 = '[[${result.gms1}]]';
            $("[name=gms1] option[value=" + gms1 + "]").prop("selected", true);
            var xsejbsc1 = '[[${result.xsejbsc1}]]';
            $("[name=xsejbsc1] option[value=" + xsejbsc1 + "]").prop("selected", true);
            var zcyy = '[[${result.zcyy}]]';
            $("[name=zcyy] option[value=" + zcyy + "]").prop("selected", true);
            var jays = '[[${result.jays}]]';
            $("[name=jays] option[value=" + jays + "]").prop("selected", true);
            var jqjh = '[[${result.jqjh}]]';
            $("[name=jqjh] option[value=" + jqjh + "]").prop("selected", true);
            var yy = '[[${result.yy}]]';
            $("[name=yy] option[value=" + yy + "]").prop("selected", true);
            var qcfmfs = '[[${result.qcfmfs}]]';
            $("[name=qcfmfs] option[value=" + qcfmfs + "]").prop("selected", true);
            var mclcfs = '[[${result.mclcfs}]]';
            $("[name=mclcfs] option[value=" + mclcfs + "]").prop("selected", true);
        }

        //单选按钮默认选中查询出来的
        var item = '[[${result.nj}]]';
        var obj = document.getElementsByName("nj");
        for (var i = 0; i < obj.length; i++) {
            if (obj[i].value == item) {
                $(obj[i]).attr("checked", "checked");
            }
        }


        //用户头像
        $(".userImage").attr("src", "/childhealth/basicData/userImage?str=" + '[[${result.tx}]]')
    })

</script>
</body>
</html>
